伴根性症状退变性腰椎管狭窄症选择性治疗策略.docVIP

伴根性症状的退变性腰椎管狭窄症的选择性治疗策略 　　[摘要] 目的 分析伴根性症状的退变性腰椎管狭窄症的特点，探讨“责任节段”的确定方法及选择性手术疗效。 方法 对上海长征医院2014年1月～2015年1月收治的58例伴有根性症状的多节段腰椎管狭窄患者资料进行分析，其中42例术前行腰椎管造影术，20例行选择性神经根阻滞术，以明确“责任节段”，均选择腰后路减压植骨融合内固定术（PLIF）治疗。参照日本骨科学会（JOA）下腰痛评分标准（29分法），对术后疗效进行评定。下地后进行步行距离记录。 结果 随访12～24个月，平均（16.16±3.70）个月。术前JOA评分为（10.86±3.23）分，末次随访评分为（22.79±3.44）分，差异有统计学意义（P 0.05）。治疗效果优良率为94.8%，步行距离由术前（636±324）m提高至末次随访时（2179±465）m，差异有统计学意义（P 0.05）。 结论 术前应综合多种诊断手段以定位根性症状来源及腰椎管狭窄的“责任节段”，选择性短节段固定可以获得良好的手术疗效。 　　[关键词] 腰椎；椎管狭窄；脊神经根；脊髓造影术；神经传导阻滞；选择性外科手术 　　[中图分类号] R683 [文献标识码] A [文章编号] 1673-7210（2016）06（c）-0097-04 　　[Abstract] Objective To analyze the characteristics of degenerative lumbar spinal stenosis accompanied with radicular symptoms， and investigate the selection of responsible segments and the effects of selective treatment strategies. Methods There were 58 patients with multi-segmental lumbar spinal stenosis accompanied with radicular symptoms in Shanghai Changzheng Hospital from January 2014 to January 2015. The clinical symptoms， physical signs and images were analyzed. The responsible segments were determined by means of lumbar myelography （42 cases） and/or selective nerve root block （20 cases） preoperatively. The patients underwent posterior lumbar interbody fusion （PLIF） with internal fixation. The operative effect was evaluated using the Japanese Orthopaedic Association （JOA-29） score system and walking distance was recorded before surgery and during the follow-up period. Results All cases were followed up for 12-24 months， average of （16.16±3.70） months. The JOA scores were respectively （10.86±3.23） and （22.79±3.44） points at pre-operation and last follow up， with a statistically significant difference （P 0.05）. The excellent and good rate was 94.8%， and walking distance was significantly increased from pre-operative （636±324） m to （2179±465） m at last follow up （P 0.05）. Conclusion It is very important to clarify the responsible segments of radicular symptoms and spinal stenosis. Selective sho